Table 3.

Intervention Titration Algorithm

Baseline Titration

Based on mean baseline study visit SBP values: Medium resource intensity – Monthly tailored RN delivered calls + home BP monitoring ➢ Mean of enrollment study visit SBPs of < 150mmHg (< 140mmHg for patients with diabetes) High resource intensity – Monthly tailored pharmacist delivered calls with additional medication management + home BP monitoring ➢ Mean of enrollment study visit SBPs of ≥ 150mmHg (≥ 140mmHg for patients with diabetes)

Planned Titration at 6 and 12 Months

Based on the mean of all available SBP values up to 31 days prior to the patients study visit, including study visit BP values, any clinic BP values, and/or any home BP values provided to during the intervention: Low resource intensity – Non-tailored LPN delivered calls occurring every two months ➢ Mean SBP controlled; i.e. <140mmHg (SBP <130mmHg for patients with diabetes). Medium resource Intensity ➢ Mean SBP (defined above) of ≥ 140mmHg and < 150mmHg (≥ 130mmHg and < 140mmHg for patients with diabetes) High resource Intensity ➢ Mean SBP (defined above) of ≥ 150mmHg (SBP ≥ 140mmHg for patients with diabetes)

Unplanned Titration Between 6 and 12 Months

Mean of home SBPs reported during a study behavioral call ≥ 160mmHg ➢ This automatic increase in resource intensity will not include adding 5mmHg to home systolic BP measurements. A minimum of 4 blood pressure readings considered to be validly reported by the appropriately licensed clinical interventionist was required. Any exception to the required number would need to be approved by the study physician or an appropriately licensed clinical backup. Hospitalization due to stroke and/or myocardial infarction. Patient will be asked at intervention phone calls if they have been hospitalized for stroke, myocardial infarction and/or heart attack. We will also make unplanned titrations due to hospitalizations that are noted by interventionists as having been recorded in the VA electronic health record. A patient triggers the safety protocol based on a blood pressure. If a patient is titrated to the highest level between study visits, they must remain at the highest intensity level for at least 6 months (for example, if a patient is up stepped at month 3, they will not be reevaluated for possible down stepping until month 12).

BP - blood pressure; mmHg – millimeters of mercury; LPN – licensed practical nurse; RN – registered nurse; SBP – systolic blood pressure; VA – Veterans Affairs